Quincy

Question 1

Presentation of quinsy (peritonsillar abscess)

Answer 1

trismus (difficult opening mouth)

uvular deviates away

severe throat pain which lateralises to one side

Question 2

SBAR quinsy… seen n GP

Answer 2

confirm who you are speaking to and tell them who you are

patients name, age and suspected diagnosis

on examination-

observations- fever?
lymphadenopathy?
oral cavity? tonsils inflamed? exudate on tonsils?
trismus present?
pain?
tonsillar swelling and uvula deviation?

ENT- can they they be seen by ENT on the same day for furhter management?

Question 3

Quinsy management

Answer 3

needle aspiration/ incision and drainage

IV antibiotics

consider tonsillectomy to prevent recurrence

Question 4

Which examinations would you like to do

Answer 4

examination of the oral cavity
neck nodes examination

consider otoscopy?

Question 5

Most common bacterial tonsillitis pathogens

Answer 5

beta haemolytic strep (group Astrep) called strep pyogenes

Question 6

Differentials

Answer 6

viral infection such as glandular fever
bacterial tonsillitis
tonsillar cellulitis
tumours- lymphoma/ carcinoma

Question 7

which IV antibiotics

Answer 7

IV benzyl penicillin
Clindamycin if penicillin allergic

add metronidazole at 48hours if not resolving

Question 8

Complications of quincy

Answer 8

sepsis
airway obstruction
haemorrhage
Lemmiere’s syndrome- infectious thrombophlebitis of the interval jugular vein
recurrence- consider tonsillectomy
deep neck space infection